Tolga Ertekin

Comparison of Three Methods for the Estimation of Total Intracranial Volume Stereologic, Planimetric, and Anthropometric Approaches

There is a well-known close relationship between the total intracranial volume (TIV) and the brain size. Several studies in different countries have estimated the cranial capacity, which indirectly reflects the brain volume. However, we have not seen a study evaluating the results of the methodologies for the assessment of TIV. This study was carried out on 30 normal subjects whose ages ranged between 19 and 77 years old (males, 18; females, 12). Three different methods were used to assess the TIV. The mean (±SD) estimated TIV using linear dimensions method in males and females were 1416.8 ± 64 cm3 and 1291.9 ± 152 cm3, respectively. The mean estimated TIV using point counting method in males and females was 1474 ± 93 cm3 and 1252 ± 72 cm3, respectively. By using the planimetric method of the mean and SD of TIV, male and females were 1492.1 ± 74 cm3 and 1319.6 ± 100 cm3, respectively. There were no statistical difference between TIV measurements obtained using the optimized stereologic technique and planimetry (P > 0.05). TIV between males and females was statistically significant (P < 0.001). This study showed that there are minor differences among the given 3 distinct methods. With the disadvantage of requiring more time to apply, the planimetry and point counting methods provide more assumption-free results than the anthropometric approach. However, the anthropometric method can be applied to assess TIV without needing sophisticated tools.

Estimation of Cranial Capacity in 17-26 Years Old University Students

Es natural que exista una relacion entre la capacidad craneana y el tamano del cerebro. Numerosos estudios realizados, han estimado la capacidad craneana con lo cual han determinado indirectamente el volumen del cerebro. El estudio fue realizado en 366 individuos (226 hombres y 140 mujeres), normales, entre 17-26 de edad, pertenecientes a grupos del Mugia Universidad de Mugia, Turquia. Para la estimacion de la capacidad craneana se utilizaron las dimensiones lineales de la cabeza. La media y SD de la capacidad craneana en hombres y mujeres, fue de 1411,64+118,9 cm3 y 1306,95+162,9 cm3, respectivamente. Las diferencias fueron estadisticamente significativas (p<0.05). La investigacion demostro que la capacidad craneana es mayor en los hombres que en las mujeres. Tambien propusimos una formula de regresion que podria ser usada para predecir la capacidad craneana

Analysis of the Volumes of the Posterior Cranial Fossa, Cerebellum, and Herniated Tonsils Using the Stereological Methods in Patients with Chiari Type I Malformation

Objective. The aim of this study was to determine the posterior cranial fossa volume, cerebellar volume, and herniated tonsillar volume in patients with chiari type I malformation and control subjects using stereological methods. Material and Methods. These volumes were estimated retrospectively using the Cavalieri principle as a point-counting technique. We used magnetic resonance images taken from 25 control subjects and 30 patients with chiari type I malformation. Results. The posterior cranial fossa volume in patients with chiari type I malformation was significantly smaller than the volume in the control subjects (P < 0.05). In the chiari type I malformation group, the cerebellar volume was smaller than the control group, but this difference was not statistically significant (P > 0.05). In the chiari type I malformation group, the ratio of cerebellar volume to posterior cranial fossa volume was higher than in the control group. We also found a positive correlation between the posterior cranial fossa volume and cerebellar volume for each of the groups (r = 0.865, P < 0.001). The mean (±SD) herniated tonsillar volume and length were 0.89 ± 0.50 cm3 and 9.63 ± 3.37 mm in the chiari type I malformation group, respectively. Conclusion. This study has shown that posterior cranial fossa and cerebellum volumes can be measured by stereological methods, and the ratio of these measurements can contribute to the evaluation of chiari type I malformation cases.

Evaluation of Lumbar Vertebral Body and Disc: A Stereological Morphometric Study

El acceso anterior a las vertebras L1-L5 y espacios entre los discos puede ser tecnicamente dificil, con frecuencia requiere la participacion de un cirujano para una exposicion adecuada. La tecnica se utiliza para la extirpacion de la lesion, corpectomia, la reconstruccion del cuerpo vertebral con jaulas, realineamiento y / o placas o tornillos. Para un enfoque exitoso anterior y un diseno adecuado instrumental a traves de tornillo, un acabado conocimiento sobre la morfometria del cuerpo de las vertebras lumbares y de los espacios entre los discos y la evaluacion volumetrica son necesarias para el neurocirujano. El objetivo fue la evaluacion morfometrica y volumetrica de los cuerpos lumbares y los discos, para contribuir al abordaje seguro durante la cirugia. Se evaluo en 25 sujetos adultos, diestros, sin antecedentes de fracturas vertebrales y de enfermedad degenerativa espinal, el cuerpo vertebral y la morfometria del disco mediante estereologia con RM. La forma de las vertebras, el indice de concavidad y la definicion de las medidas volumetricas de los cuerpos L1-L5. Ademas, se midieron los parametros morfometricos como longitud, altura, ancho del cuerpo vertebral. Se efectuo un analisis morfometrico y volumetrico de loss cortes axiales y sagitales de los discos entre L1 y L5. Como era de esperar, las dimensiones promedio de las vertebras en los hombres fueron mayores que en las mujeres, pero la mayoria de ellos no son estadisticamente significativas. Solo tres dimensiones, la diferencia promedio entre la altura anterior y central de las vertebras L3, L4 y L5 mostraron diferencias estadisticamente significativas, indicando menor altura central tanto en los hombres como en las mujeres. Los diametros transversal y anteroposterior del cuerpo vertebral, la altura del disco intervertebral y el volumen no mostraron dimorfismo sexual (p>0,05). Sin embargo, aumentaron la altura del disco intervertebral y el volumen de L1 a L5 (p<0,01). Los indices de concavidad, de todas las vertebras lumbares, para ambos sexos, no diferian estadisticamente. El metodo es importante para el neurocirujano, para estimar el tamano y cantidad del implante y su aplicacion en las cirugias de descompresion.

Lumbar vertebra morphometry and stereological assesment of intervertebral space volumetry: a methodological study.

The use of technology in the treatment of degenerative spinal diseases has undergone rapid clinical and scientific development. It has been extensively studied in combination with various techniques for spinal stabilization from both the anterior and posterior approach. Minimally invasive and instrumental approach via posterior fixation is increasingly being used for the treatment of adult degenerative disc disease, stenosis, and deformity of the lumbar vertebrae. Posterior access to the lumbar disc spaces for posterolateral fusion scan has been technically challenging, frequently requiring the use of an approach surgery for adequate exposure. For successful surgery and suitable instrumental design, adequate anatomical knowledge of the lumbar vertebra is also needed. Anatomic features of lumbar vertebrae are of importance for posterior screw fixation technique. The morphometry of L1-L5 has been studied to facilitate the safe application of pedicle screws. Thus, we aimed to evaluate the morphometric landmarks of lumbar vertebrae such as pedicle, vertebral body, vertebral foramen, intervertebral space height and volume for safe surgical intervention using a posterior fixation approach to offer anatomical supports for lumbar discectomy, stenosis and cases of deformity. The features of the L1-L5 vertebral body, the detailed morphometric parameters of lumbar vertebrae and the intervertebral space were analyzed using computerized tomography scan, magnetic resonance imaging and also dry lumbar vertebrae. Additionally, intervertebral space volumes were measured using stereological methods to ensure safe surgical intervention.

Evaluation of Cerebellar and Cerebral Volume in Migraine with Aura: A Stereological Study

Migraine is associated with an increased risk of deep white matter lesions and subclinical posterior circulation infarcts. A significant association between deep white matter hyperintensities and cerebral atrophy is true for various neurological diseases; it was not specifically proven in migraine. The aim of this study was to evaluate the cerebellar and cerebral volume and volume ratios for cerebellum using the Cavalieri principle. We also aimed to examine whether migraine with aura causes cerebellar and cerebral atrophy. Twenty three right-handed patients with migraine with aura diagnosed by means of the International Headache Society criteria and 24 age-matched subjects whose only health problem was headache due to rhinosinusitis and tension type headache were included in the study. Measurements of the cerebellar and cerebral volumes as well as cerebellar/cerebral volume ratios were made using Cavalieri’s principle by utilizing the point-counting methods. There were no significant differences between the volumes of cerebrum, cerebellum, and the ratio of cerebellum to cerebrum for males (p = 0.05, p = 0.10, and p = 0.64, respectively) and for females (p = 0.18, p = 0.89, and p = 0.24, respectively). Our results suggest that patients with migraine with aura do not have a significant difference in cerebellar and cerebral volumes and cerebellar/cerebral volume ratios compared to the non-migraine group.

Evaluation of Cerebellar Asymmetry in Alzheimer's Disease: A Stereological Study

Objectives: Alzheimer’s disease (AD) is the most common cause of dementia and, as previous studies have indicated, degenerative changes in the cerebellum occur in AD. It is well known that the cerebellum does not have a symmetric morphology and some pathological disorders, such as schizophrenia, epilepsy, autism and alcoholism, can cause asymmetrical changes in the cerebellum. In this study, we aimed to evaluate whether or not patients with AD show cerebellar asymmetry. We also intended to depict the probable volumetric asymmetry by using a stereological technique. Materials and Methods: The study evaluated the volu- metric measurements of each cerebellar hemisphere by applying a stereological method to MR images. This age- and gender-matched study was composed of 15 patients with probable AD and 14 healthy subjects (controls). MR images were analyzed by using the point-counting approach, holding to Cavalieri’s principle. Results: Although there was significant cerebellar atrophy in AD patients, the study showed no statistically significant cerebellar asymmetry according to age and gender, both in the study and control groups (p > 0.05). Conclusions: There was no difference in cerebellar asymmetry associated with age and gender between the AD patients and control subjects. The stereological evaluation of cerebellar asymmetry correlating with gender is of importance to both clinicians and anatomists. The technique is simple, inexpensive, reliable and unbiased.

Influence of gilaburu (Viburnum opulus) juice on 1,2-dimethylhydrazine (DMH)-induced colon cancer.

In this study, the effects of gilaburu (Viburnum opulus) juice on colon tumorogenesis were investigated. Eight weeks old Balb-C male mice received subcutaneous injections of 1,2-dimethylhydrazine (DMH) (20 mg/kg body weight) once a week for 12 weeks. Both the sham control (group 1) and the DMH control (group 2) groups received drinking water alone, whereas the mice of groups 3 and 4 received gilaburu juice for 30 weeks (started with first DMH injection) and for 18 weeks (started after last DMH injection), respectively. Eighteen weeks after the last DMH injection, all mice were killed and the histogenesis of colon tumors was investigated from the paraffin-embedded sections of colon, which were stained with hematoxylin–eosin. The sites and incidences of tumoral lesions (low-grade dysplasia, high-grade dysplasia, intramucosal carcinoma and invasive carcinoma) were analyzed and compared with control. The results showed that the body weights of the mice were similar in all the groups. No tumoral lesions were found in group 1. Colon tumors developed in all DMH-treated mice (groups 2, 3 and 4). In these groups, the greatest numbers of tumor lesions were detected in the distal colon, followed by the mid-colon and only a few in the proximal colon. There was a reduction in the mean total number of tumor lesion in groups 3 (8.5) and 4 (8.3), when compared to group 2 (11.3). The incidence of invasive carcinoma in group 3 was significantly lower than group 2 (p < 0.05). On the basis of these results, we conclude that gilaburu juice may be useful for the prevention of colon cancer at the initiation stage.

The Age-related Development of Maxillary Sinus in Children

Introduction:Paranasal sinuses are complex structures and show individual variation. Providing normative values for paranasal sinus size and their changes related to age could be helpful in evaluating the presence of some diseases related to sinonasal region. The purpose of the current study was to investigate the development of maxillary sinuses and evaluate the volume changes according to age and sex by using stereological and ellipsoidal formula methods after that to compare these approaches with each other in children. Materials and Methods:This retrospective volumetric computed tomography (CT) study was carried out on 361 individuals (180 females, 181 males) between 0 and 18 years old (10 females, 10 males in each group, only 14 age group includes 11 males) with no signs of sinus pathology volumetric estimations determined on CT images using point-counting approach of stereological methods and ellipsoid formula by using morphometric data. Results:Maxillary sinus volume measurements that were obtained using 2 methods were increased with age in both sexes until 16 years old. There was a significant correlation determined between 2 methods (ICC 0.894–1.000 for right and 0.862–0.999 for left maxillary sinus measurements). According to the sex, the right and left mean maxillary sinuses volumes were determined at 8.30 ± 5.19 and 8.57 ± 5.53 cm3 in male and at 7.60 ± 4.57 and 7.99 ± 4.73 cm3 in female by using ellipsoid formula respectively. By the stereological method these values were 8.28 ± 5.26, 8.44 ± 5.35 cm3 and 7.64 ± 4.55, 7.85 ± 4.73 cm3 respectively. There was no statistically significant difference between the volume of maxillary sinuses with sex and side using both methods. Conclusions:This study presents the basic data for studies relative to the development of the maxillary sinus in children according to 2 methods. The current study demonstrated that the point-counting method and ellipsoid formula are both effective in determining volume estimation of maxillary sinuses and are well suited for CT studies.

Morphometric Analysis of Hemicerebellar Asymmetryn with Central Vertigo Cases: A Stereological Study

Nuestro objetivo fue evaluar los metodos relevantes de estereologia para estimar la asimetria hemicerebellar segun el genero, tanto en adultos diestros, casos de vertigo y al compararlos con casos control. El estudio incluyo a 14 sujetos adultos como control y 18 pacientes con vertigo. Los volumenes de los hemisferios del cerebelo se determinaron en la RM utilizando el recuento de los puntos del metodo de estereologia. La media (± DE) de los hemisferios derecho del cerebelo en los pacientes con vertigo fueron 52,49 ± 5,42 cm3 en los hombres, 50,11 ± 4,02 cm3 en las mujeres. La media (± DE) de los hemisferios izquierdo del cerebelo en los pacientes con vertigo fueron 53,11 ± 3,70 cm3 en los hombres, 49,73 ± 4,69 cm3 en las mujeres. No hubo evidencia cuantitativa importante detectada en cuanto a la asimetria entre las estimaciones del cerebelo entre plano sagital en los casos con vertigo en ambos sexos (p> 0,05). No hubo diferencias estadisticamente significativas segun los generos entre ambos el vertigo y los sujetos control (p> 0,05). Solo hubo significancia estadistica entre los hemisferios derecho e izquierdo en los sujetos control masculino (p = 0,039). No hubo asimetria entre el cerebelo control y de los casos el vertigo de acuerdo a los generos. La evaluacion de la asimetria estereologica o atrofia del cerebelo en el ser humano se correlaciona con el genero es de importancia para los clinicos y anatomicos. La tecnica es simple, confiable, de bajo costo e imparcial.